Parameters of inflammation and infection in a community based case-control study of coronary heart disease

Background: increased levels of systemic inflammatory markers appear to be related to coronary heart disease (CHID) both in asymptomatic individuals and in subjects with established CHID, Whether these associations are related to confounding coronary risk factors or are explicable through chronic infectious conditions is not clear. Objectives: (1) to determine whether subjects with stable CHD differ from normal controls in inflammatory markers (CRP, SAA and fibrinogen) and/or in serostatus of four infectious agents (Helicobacter pylori, Chlamydia pneumoniae, CMV and EBV), independent of classical coronary risk factors. (2) To determine whether these inflammatory markers are related to the serostatus against these four infectious agents either in patients with CHD or in normal subjects. Methods: in a large epidemiologic survey, 446 out of 16307 then at work, aged 35-59 years, had antecedents of myocardial infarction. CABG or PTCA or had prominent Q/QS waves on their resting ECG. They were compared with double the number (n = 892) of men, matched for age, educational level and industry. Inflammatory biomarkers CRP. fibrinogen and SAA and antibodies against H. pylori, C. pneumoniae, CMV and EBV were measured, besides classical coronary risk factors. Results: in univariate analyses. cases had higher CRP. fibrinogen and SAA levels than controls, but no differences were observed in serumantibody levels to any of the infectious agents. Markers of previous infections were not related to inflammatory biomarkers. In multivariate analyses CRP was significantly different between cases and controls independent of differences in other coronary risk factors and in the use of lipid lowering drugs and antiplatelet aggregants. Conclusion: in men at work with CHID, CRP levels are significantly different from controls. independent of known risk factors. No association was found between inflammatory biomarkers and positive serostatus against four infectious agents, neither in the patients nor in the healthy controls. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.